改良前臂背側筋膜脂肪瓣治療創傷性尺橈骨骨性連接_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 王孝輝

河南省洛陽正骨醫院河南省骨科醫院手顯微外科, 河南洛陽, 471002;

Corresponding?author：

王孝輝, Email: 963099784@qq.com

Keywords：

尺橈骨骨性連接; 筋膜脂肪瓣; 骨折; 并發癥

DOI：

10.7507/1002-1892.20160185

Video：

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目的總結改良前臂背側筋膜脂肪瓣治療創傷性尺橈骨骨性連接的療效。方法 2007年3月-2013年6月，采用改良前臂背側筋膜脂肪瓣環繞尺骨治療創傷性尺橈骨骨性連接患者12例。男7例，女5例；年齡18～60歲，平均23.5歲。單一骨折2例，雙骨折10例。傷后均行切開復位鈦板內固定治療。內固定術后至該次手術時間為9～15個月，平均11.5個月。按Hastings及Graham分類標準：3區4例，4區8例。3區患者前臂旋轉范圍為（18.0±3.5）°，4區患者為（20.0±4.5）°。肘關節功能Mayo評分為（55.0±4.5）分，上肢功能評定表（DASH）評分為（56.0±7.5）分。結果患者術后切口均Ⅰ期愈合。12例均獲隨訪，隨訪時間1.6～2.7年，平均2.0年。2例合并骨間背神經損傷者術后存在前臂背側局部感覺麻木，6個月后癥狀消失。X線片復查示，術后4個月3區及4區患者各1例原骨性愈合處少許骨質生長，但骨性連接未形成；其余患者未見骨質再生。末次隨訪時，患者前臂主動旋轉功能均較術前顯著改善；其中3區患者前臂旋轉范圍為（144.0±3.5）°，4區患者為（135.0±4.5）°，與術前比較差異有統計學意義（t=2.738，P=0.038；t=5.872，P=0.006）。Mayo評分為（87.5±5.5）分，DASH評分為（12.5±4.5）分，與術前比較差異均有統計學意義（t=2.283，P=0.027；t=4.765，P=0.008）。結論前臂背側改良筋膜脂肪瓣治療創傷性尺橈骨骨性連接，患者前臂旋轉功能改善明顯。

Citation： 王孝輝. 改良前臂背側筋膜脂肪瓣治療創傷性尺橈骨骨性連接. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 919-920. doi: 10.7507/1002-1892.20160185 Copy

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1. Sonderegger J, Gidwani S, Ross M. Preventing recurrence of radiolunar synostosis with pedicled adipofascial flaps. J Hand Surg (Eur Vol), 2012, 37(3): 244-250.
2. Hastings H 2nd, Graham TJ. The classfication and treatment of heterotopic ossification about the elbow and forearm. Hand Clin, 1994, 10(3): 417-437.
3. Vince KG, Miller JE. Cross-union complicating fracture on the forearm. PartⅡ: Children. J Bone Joint Surg (Am), 1987, 69(5): 654-661.
4. Wierer M, Huber-Wagner S, Mutschler W. Post-traumatic proximal radioulnar synostosis. Surgical technique and review of the literature. Unfallchirurg, 2012, 115(5): 451-456.
5. Daluiski A, Schreiber JJ, Paul S, et al. Outcomes of anconeus interposition for proximal radioulnar synostosis. J Shoulder Elbow Surg, 2014, 23(12): 1882-1887.
6. Kamrani RS, Ahangar P, Nabian MH. Proximal radial diaphyseal segment resection for posttraumatic proximal radioulnar synostosis: a prospective study of 15 cases. J Shoulder Elbow Surg, 2014, 23(6): 855-860.
7. Dohn P, Khiami F, Rolland E, et al. Adult post-traumatic radioulnar synostosis. Orthop Traumatol Surg Res, 2012, 98(6): 709-714.

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Chinese Journal of Reparative and Reconstructive Surgery

改良前臂背側筋膜脂肪瓣治療創傷性尺橈骨骨性連接

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